UCLA: Findings from the 2009 California Health Interview Survey

The UCLA Center for Health Policy Research’s new report, The State of Health Insurance in California: Findings from the 2009 California Health Interview Survey, sheds light on the effects of the recession on insurance coverage and access to care to millions of Californians.

The study finds that 7.1 million Californians were uninsured in 2009, amounting to 21.1% of nonelderly Californians who had no health insurance coverage for all or some of 2009. This is up nearly 2 percentage points from 2007. The loss of employment-sponsored insurance increased uninsurance, which fell 3.5 percentage points from 2007, when 55.6% had coverage from their own or a family member’s job, to 52.1% in 2009.

The fall in employment-sponsored insurance, driven largely by rising unemployment, has left California with an uninsured rate about 3 percentage points higher than the U.S. average.

The impact of declining health insurance coverage and incomes leave low-income children and adults, populations of color, and immigrants disproportionately worse off and stand to only further exacerbate disparities in health outcomes.

In light of painting a seemingly bleak picture for the uninsured in California, the authors bring balance by highlighting the ACA’s potential ability to expand coverage and access to care for millions.

In total, there are five chapters to this report. Listed here are some key findings from each.

Chapter 1: The Effects of the Great Recession on Health Insurance in California

Those with employment-based coverage remained in the majority in 2009, at 52% of the population.

Public coverage climbed to insure 31.8% of all children in the state. Uninsurance among children dropped to 9.8%, continuing the declining trend from the past decade.

When the ACA is fully implemented in 2014, 42.9% of nonelderly uninsured Californians will be eligible to enroll in Medi-Cal under the expanded household income requirements

Los Angeles County has the largest proportion of uninsured who will be ineligible to either purchase coverage in the Exchange or enroll in Medi-Cal due to their citizenship and immigration status, with one-fifth of this group being ineligible for both (20.7%)

In 2001, the uninsurance rate among nonelderly Latinos was at its height, at 34.6%. That dropped to 28.6% by 2007, but rose again with the 2009 recession, to 30.1%. Nonelderly Latinos continued to have the lowest rates of job-based insurance, with the recession erasing prior gains and dropping the rate to a decade low of 36%.

About four in ten of the uninsured non-Latino White population will be eligible to gain coverage through expanded Medi-Cal program under ACA (39.5%). Another one-third will be eligible for federal subsidies to purchase insurance through the new Exchange (31.4%), and nearly all of the rest will be able to buy in the Exchange with their own funds (28.5%).

African Americans will have among the highest rates of eligibility for the Medi-Cal expansion (49.5%), and the rest of these populations will be eligible for the Exchange, either with or without subsidies.

Chapter 3: Job-Based Coverage and the Individual Market

The share of nonelderly adults with employment-based coverage fell by 670,000 between 2007 and 2009. The main source of the decline was the loss of full-time work in the state. The number of adults with full-time employment fell by 1.4 million between 2007 and 2009.

The share of nonelderly Californians with employment-based coverage ranged from a low of 36% in Kings County to a high of 73.6% in San Mateo County.

Workers in low-income families (i.e., under 200% FPL) were only one-third as likely to have employment-based coverage as workers in higher-income families (above 400% FPL).

Individuals who are uninsured and would be eligible for subsidies under the ACA are younger on average than those currently in the individual market, but they are more likely to report fair or poor health status.

Chapter 4: Medi-Cal, Healthy Families, and Medicare Play a Vital Role in Insuring Californians

Over one-quarter (26.7%) of children ages 0–18 had Medi-Cal coverage in 2009, compared to 24.7% in 2007, prior to the Great Recession.

The main source of the increase was the loss of full-time work in the state. The number of adults with full-time employment fell by 1.4 million between 2007 and 2009. While their children were able to qualify for and enroll in Medi-Cal or Healthy Families, the percentage of adults who had Medi-Cal all year actually decreased slightly (9.0% to 8.7%), while the proportion of uninsured adults increased from 23.9% to 26.6%.

Medi-Cal beneficiaries were primarily made up of individuals up to the age of 18 (51%), with the other large groups being younger adults (ages 19–34), representing 13.8% of all beneficiaries, and older adults ages 65 and up (13.6%). The adult population represented only 35.4% of the Medi-Cal population, despite making up 60% of California’s population.

Like Medi-Cal, close to three-quarters of the Healthy Families population were Latino citizens and legal permanent residents (75% of children ages 0–5 and 69.1% of those ages 6–18).

Chapter 5: The Role of Insurance in Access to Care

Uninsured children (41.8%) and adults (49.9%) more frequently reported not having seen a provider in the past year than their counterparts with employment-based insurance (8.3% and 13.4%, respectively). In contrast, the employment-based insured children (20.5%) and adults (26%) were more likely than uninsured children and adults to have made five or more visits to providers (4.7% and 6.2%, respectively).

The uninsured were also more likely than the insured to forgo or delay needed medical care due to costs or lack of insurance; 5.7% of those with employment-based insurance reported such barriers, compared to 19.5% of the uninsured.